Figure 4 – Ulcers have developed on the leg of this patient with stasis dermatitis.
Etiology. The etiology of stasis dermatitis is complex. Alteration of deep venous plexus function of the leg leads to the backflow of blood to the superficial venous system, which causes venous hypertension and cutaneous inflammation.
Clinical features. Stasis dermatitis usually affects the lower extremities, often in areas of long-standing venous insufficiency, and is more common in women. The bilateral circumferential dermatitis is characterized by lichenified and hyperpigmented plaques on the ankle and calf areas (Figure 1). The triad of alopecia, waxy appearance, and yellowbrown pigment from hemosiderin deposition is highly specific for stasis dermatitis with or without pitting edema (Figure 2). Secondary infection can develop (Figure 3). Ulcerations may also occur (Figure 4). Stasis dermatitis can be misdiagnosed as cellulitis.
Figure 5 – This violaceous nodule resembles classic Kaposi sarcoma but is actually a rare manifestation of stasis dermatitis, which has been called pseudo–Kaposi sarcoma, or acroangiodermatitis.
Rarely, stasis dermatitis is associated with the development of violaceous plaques and nodules on the legs and the dorsal part of the feet; these lesions resemble classic Kaposi sarcoma (Figure 5). As a result, this manifestation has been called pseudo–Kaposi sarcoma, or acroangiodermatitis.
In immobile elderly patients, stasis dermatitis–like eruptions and pressure ulcers can occur at sites other than the legs, such as the buttocks, heels, forearms, and any other body area that rests on a solid surface and is exposed to long-term pressure.
Figure 6 – Irritant contact dermatitis developed in this elderly woman on the areas where she had applied a topical medication.
Treatment. The goal of treatment is to mitigate the effects of venous insufficiency. Consider ordering venous Doppler studies to determine whether vascular surgery is needed. Compression therapy can be administered to control the amount of pressure on the legs. Support stockings, elastic wraps, and Unna boots are examples of devices that can be used on affected legs. Both regular exercise and elevation of the legs 6 inches above the heart have been shown to be effective treatment measures.2
Topical corticosteroids used to treat stasis dermatitis can cause infection if the patient has open excoriations. Topical antibiotics, such as mupirocin(Drug information on mupirocin), should also be used. Avoid bacitracin(Drug information on bacitracin), which can cause contact dermatitis.3